Phoebe Starr

Authored Items

Adjuvant chemotherapy had impressive gains in disease-free survival (DFS) and metastasis-free survival versus surveillance in upper-tract urothelial cancer (UTUC), according to the results of the phase 3 POUT clinical trial that were presented at the 2018 Genitourinary Cancers Symposium. There was a suggestion of a survival gain with chemotherapy, but longer follow-up is needed.
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Adding brentuximab vedotin (Adcetris) to doxorubicin, vinblastine, and dacarbazine (A+AVD) instead of the standard regimen with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) as frontline treatment for advanced Hodgkin lymphoma reduced the risk for disease progression, death, or the need for additional therapy by 23%, according to new data presented at ASH 2017.
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Direct oral anticoagulants (DOACs) may soon replace low-molecular-weight heparin (LMWH) as the standard of care for the management of venous thromboembolism (VTE) in patients with cancer, judging by the results of 2 randomized trials presented at ASH 2017. The caveat is that DOACs are associated with more bleeding events, especially in patients with gastrointestinal (GI) cancer who should continue receiving LMWH.
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The data for CD19-directed chimeric antigen receptor (CAR) T-cell therapy continue to show excellent and durable responses in patients with lymphoma who have no other treatment options. Two studies presented at ASH 2017 provide encouraging news for 2 new drugs, including long-term follow-up of the pivotal ZUMA-1 study of the CAR T-cell therapy axicabtagene ciloleucel (Yescarta), and primary results from the JULIET study of tisagenlecleucel (Kymriah).
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Older patients with hormone receptor–positive, HER2-­negative, metastatic breast cancer derive similar benefit as younger patients who received cyclin-dependent kinase (CDK)4/CDK6 inhibitors as part of their initial endocrine therapy, according to a pooled analysis of clinical trials presented at the 2017 San Antonio Breast Cancer Symposium.
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Key presentations featured during press conferences at the 2017 San Antonio Breast Cancer Symposium have important practical implications for oncologists and other providers who manage patients with breast cancer.
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San Diego, CA—The National Comprehensive Cancer Network (NCCN) estimates that at least 33% of patients with cancer have significant psychological distress, and many patients have some levels of distress. High levels of distress are associated with negative outcomes from cancer treatment. The psychological well-­being of patients with cancer has been less well-studied than the effects of treatments, but recently, more attention is focused on the “whole patient.”
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Ramucirumab (Cyramza), a vascular endothelial growth factor receptor 2 inhibitor, added to docetaxel improved progression-free survival (PFS) and nearly doubled the objective response rate (ORR) compared with docetaxel monotherapy in patients with advanced or metastatic urothelial cancer that progressed with platinum-based chemotherapy in the phase 3 RANGE clinical trial. This is the first phase 3 clinical trial to show a PFS advantage over chemotherapy alone in this setting. Lead investigator Daniel P. Petrylak, MD, Professor of Medicine and of Urol­ogy, Yale School of Medicine and Yale Cancer Center, New Haven, CT, presented the results at the 2017 European Society for Medical Oncology (ESMO) Congress.
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The addition of the cyclin-dependent kinase (CDK)4/CDK6 inhibitor abemaciclib (Verzenio) to an aromatase inhibitor improved progression-free survival (PFS) over aromatase inhibitor monotherapy in women with hormone receptor (HR)-positive, HER2-­negative advanced breast cancer, according to an interim analysis of the phase 3 MONARCH 3 clinical trial presented at the 2017 European Society for Medical Oncology (ESMO) Congress. The study was also re­cently published in the Journal of Clinical Oncology.
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Madrid, Spain—Findings from a randomized clinical trial suggest that follow-up computed tomography (CT) scans in patients with fully resected non–small-cell lung cancer (NSCLC) may not be needed every 3 to 6 months in the first 2 years after surgery. Results of the IFCT-0302 study were presented at the 2017 European Society for Medical Oncology (ESMO) Congress, showing no significant difference in overall survival (OS) among patients who had CT scans as part of their follow-up versus those who did not.
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Madrid, Spain—Durvalumab (Imfinzi), a PD-L1 inhibitor, improved progression-free survival (PFS) by 11.2 months compared with placebo in patients with locally advanced, unresectable stage III non–small-cell lung cancer (NSCLC) that did not progress after standard treatment with chemoradiotherapy. These results—presented at the 2017 European Society for Medical Oncology (ESMO) Congress—come from PACIFIC, the first phase 3 clinical trial of a PD-L1 inhibitor in patients with locally advanced NSCLC outside of the metastatic setting.
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Chicago, IL—Larotrectinib (LOXO-101), an investigational agent that targets tropomyosin receptor kinase (TRK) fusions, has demonstrated excellent, consistent, and durable antitumor activity in a range of tumor types in adults and children, reported lead investigator David M. Hyman, MD, Chief, Early Drug Development Service, Memorial Sloan Kettering Cancer Center, New York City, at the 2017 ASCO annual meeting. Larotrectinib was called “the first oral tumor-agnostic therapy,” because of its unprecedented high response rates in 17 tumor types that express TRK.
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San Antonio, TX—The cost of cancer drugs has increased exponentially over the past decade, straining the healthcare system and patients’ ability to pay for them. Cancer treatments that cost $150,000 or more are not unusual in the United States. Pharmaceutical manufacturers continue to increase drug prices through packaging maneuvers and the use of artificial expiration dates, and as a result, some old drugs “in new clothing” remain expensive.
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Chicago, IL—A new high-intensity genomic sequencing strategy (developed by Grail Inc) detects circulating tumor DNA (ctDNA) at a high rate. The new approach is a major improvement on previous tests using ctDNA, which focus on a limited number of driver mutations to inform treatment strategies for metastatic disease or to monitor disease burden. The new test offers ultra-deep sequencing with a broad genomic coverage, but it is not ready for prime time to detect occult cancer. At present, the test is a research platform and is not commercially available.
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Washington, DC—Adding the investigational drug indoximod, an indole­amine 2,3-dioxygenase (IDO) pathway inhibitor, to the checkpoint inhibitor pembrolizumab (Keytruda) led to higher response rates in patients with advanced melanoma than what is reported with pembrolizumab monotherapy, said lead investigator Yousef Zakharia, MD, Clinical Assistant Professor of Internal Medicine, Division of Hema­tology, Oncology and Blood and Marrow Transplantation, University of Iowa, Iowa City, at the 2017 American Association for Cancer Research meeting.
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Washington, DC—Preliminary data show excellent and durable responses to atezolizumab (Tecentriq) in 10% of women with triple-negative breast cancer, one of the most aggressive and difficult-to-treat cancers. Of the responders to atezolizumab, 100% were alive at 1 year compared with only 38% of nonresponders. The trick will be to identify which women will respond to immune checkpoint inhibitor therapy. Thus far, no biomarkers for response have been identified.
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Washington, DC—In the longest follow-up on single-agent nivolumab (Opdivo) to date, 5-year overall survival was 16% in patients with advanced non–small-cell lung cancer (NSCLC) in the updated results of a phase 1b dose-ranging study (CA209-003). This represents a quadrupling of 5-year overall survival with standard platinum doublets, which is approximately 4% for patients with metastatic NSCLC.
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The investigational drug pacritinib, a JAK1/JAK2 inhibitor, achieved benefits in patients with myelofibrosis, including a significant reduction in the spleen volume compared with the best available therapy that included the JAK1/JAK2 inhibitor ruxolitinib (Jakafi), according to the phase 3 PERSIST-2 clinical trial. The results were presented by John O. Mascarenhas, MD, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, at the 2016 American Society of Hematology (ASH) meeting.
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Extended adjuvant endocrine therapy beyond 5 years with an aromatase inhibitor (AI) failed to improve disease-free survival (DFS) in patients with hormone receptor (HR)-positive breast cancer who were enrolled in the 3 large National Surgical Adjuvant Breast and Bowel Project (NSABP) B-52, IDEAL, and DATA studies, which were presented at the 2016 San Antonio Breast Cancer Symposium.
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The investigational chimeric antigen receptor (CAR) T-cell therapy KTE-C19 achieved complete responses that were durable for >1 year in more than 75% of patients with aggressive lymphomas who had no other effective treatment options, according to results from the phase 2 pivotal clinical trial ZUMA-1 that were presented by Sattva S. Neelapu, MD, Department of Lymphoma/Myeloma, M.D. Anderson Cancer Center, at the 2016 American Society of Hematology meeting.
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Although tyrosine kinase inhibitors (TKIs), including imatinib (Gleevec), nilotinib (Tasigna), and dasatinib (Sprycel), have dramatically improved outcomes in patients with chronic myeloid leukemia (CML), the costs of these drugs have spiraled out of control, causing some patients to stop treatment or cut their dosage because of financial toxicity. Data presented at the 2016 American Society of Hematology meeting show that it is possible for some patients with CML to reduce their TKI dose by 50% and maintain remission, perhaps even stop treatment altogether once deep and durable remission has been achieved after approximately 5 years of treatment.
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Men with intermediate-risk prostate cancer can safely undergo radiation administered in larger fractions for 4 weeks (moderate hypofractionation) as an alternative to conventional radiation administered for 8 weeks, according to the results of a randomized, controlled, noninferiority clinical trial presented [ Read More ]

Aggressive end-of-life care for patients with terminal cancer and other illnesses is costly and not recommended. The American Society of Clinical Oncology (ASCO) recommends that patients with terminal cancer should receive palliative care rather than interventions that do not prolong [ Read More ]

Experience at a high-volume cancer center suggests that nonstereotactic body radiotherapy external beam reirradiation of the pelvis for cancer recurrence or for a second genitourinary malignancy is safe in patients with advanced cancer, and can achieve excellent and durable palliation [ Read More ]

Contemporary treatment has led to improvements in survival for all patients with metastatic testicular germ-cell tumors (GCTs), including poor-risk patients, although they still have worse survival. A new study shows that if poor-risk patients receive curative therapy and survive for [ Read More ]

Idelalisib (Zydelig) reduced the risk for disease progression and death when added to bendamustine (Treanda) plus rituximab (Rituxan) versus bendamustine plus rituximab alone in patients with relapsed or refractory chronic lymphocytic leukemia (CLL), according to the results of a randomized, [ Read More ]

Results from the large, randomized PIVOT clinical trial that were published in 2012 initially showed that at a median follow-up of 19 years, radical prostatectomy neither improved overall survival nor reduced death related to prostate cancer compared with “watchful waiting” [ Read More ]

A liquid biopsy using phlebotomy blood samples can identify phenotypes and genomic characteristics of circulating tumor cells that may personalize treatment selection for men with advanced prostate cancer, according to the results of a study presented by Howard I. Scher, [ Read More ]

The regular use of aspirin reduces the incidence of and risk for death from lethal prostate cancer according to the results of a large observational study reported at the 2016 ASCO Genitourinary Cancers Symposium. For the purposes of this study, [ Read More ]

An innovative care model program for end-of-life care for patients with cancer improved symptom management, reduced hospitalizations and in-hospital deaths, and increased the use of hospice care. Moreover, the model saved approximately $7000 per patient in the cost of care. [ Read More ]

Washington, DC—Tobacco use among patients with cancer is an important, but often overlooked, issue that requires intervention by oncology practices. In recognition of the problem and the gap between the need for intervention and the services delivered, the American Association [ Read More ]